You have heard the term "Integrative Medicine," but what does it means to you? Do you consider the term to be the future of healthcare or is it folly? Are there any pragmatic reasons to practice integrative medicine or is it a foolish waste of time?
I have been a licensed chiropractor for forty years. Currently, I treat patients suffering with chronic pain. Usually, these patients present with many co-morbidities that include obesity, addictions, hypertension, diabetes, and mental illness. Primary care providers refer patients for chiropractic medicine to relieve pain without the use of additional pharmaceuticals. My interventions include a detailed history, physical examination, differential diagnosis, spinal and joint manipulations, soft tissue treatments, exercise instructions, postural advice, dietary directions including proper hydration, and other salubrious recommendations that are within my scope of practice as a chiropractor in Connecticut.
My success as a chiropractic clinician is the result of proper patient assessment."Diagnosis is the key to successful treatment." I do not use any modalities, not even ice or heat, nor do I prescribe drugs but I do practice chiropractic medicine and integrative medicine. I make that claim because I am an evidence-based, patient-centered clinician that serves the needs of my patients and their primary care providers by offering holistic care within a patient-centered medical home.
Some chiropractors boldly state that they do not practice medicine and denigrate the use of the terms chiropractic medicine or integrative medicine by chiropractors. These same doctors probably consider integrative medicine to be a folly. I consider this position ignorant and detrimental to the future of the profession because the combination of chiropractic medicine and integrative medicine is the future of the chiropractic profession. Of course, chiropractors practice chiropractic medicine and patient-centered clinicians recognize the importance of integrative medicine.
History of Integrative Medicine
Dr. David Eisenberg, a Harvard medical scientist initiated the discussion that created the term "Integrative Medicine." His national survey in 1993 revealed that consumers wanted more choices from the medical system.Patients did not want to abandon the American healthcare system but sought alternatives to allopathic medicine and surgery. The practitioners most often sought were chiropractors and massage therapists. This trend alarmed allopathic physicians and insurance executives, which prompted investigation. They discovered that patients wanted the integration of all medical services into the healthcare system including chiropractic medicine.
The Bravewell Foundation claims that integrative medicine is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person's health. Employing a personalized strategy that considers the patient's unique conditions, needs and circumstances, integrative medicine uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimal health.
The integrative approach puts the patient at the center, addressing not just symptoms, but the real causes of illness. It is (health) care that is preventive, predictive and personalized.
I have read that others consider integrative medicine to be the "new medicine" because it emphasizes the relationship between the doctor and patient, the innate healing ability of the body and the importance of addressing all aspects of an individual's life to attain optimal health and healing.
A Bravewell report, "The Efficacy and Cost-Effectiveness of Integrative Medicine" mentions a pilot study involving the treatment of low back pain with integrative medicine.
[pb]A recent trial at the Ford Motor Company Assembly Plant, which tested an integrative medicine intervention for lower back pain (acupuncture and mind-body practices for stress reduction), found a significant reduction in prescription pain medication intake, suggesting a potential long-term economic benefit to the company.
Integrative Medicine and the Affordable Care Act
Integrative medicine has emerged as a potential solution to the American health care crisis. It provides care that is patient-centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy.
John Weeks recently blogged in the Huffington Post that leaders of the accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) prompted by Obamacare believe these new models will potentiate integrative approaches. He also wrote that integrative health care at its best is team care, using medical doctors, acupuncturists, chiropractors, counselors, coaches and others as appropriate.
How to Prosper as Healthcare Reforms
If you want to enjoy the opportunities to provide your holistic, patient-centered, integrative medicine services to patients, you must become involved in the healthcare reform activities in your community. Discuss your desire to provide care within patient-centered medical homes with local medical doctors, insurance executives, and politicians. Contact Federally Qualified Health Centers, such as community health centers and express your interest in providing chiropractic medical services for the relief of acute and chronic pain.
I suggested the founding of integrative medicine centers of excellence by colleges of chiropractic employing clinical faculties comprised of allopathic, chiropractic, osteopathic, and naturopathic physicians. Initially, the health care facilities could offer primary care through an integrative medicine model. These centers of excellence should seek both government and private funding in order to develop research programs, provide high-quality patient care, and improve the medical training for students with residents programs. Chiropractic institutions have yet to act on this suggestion in spite of the millions of dollars made available by the Affordable Care Act for this type of integrative medicine education and research.
While I suggest that chiropractors with no interest in the integrative medicine movement may have trouble with healthcare reform, informed chiropractors may integrate successfully into the healthcare system of the future. You should not remain ignorant of the current trends in health care reform and the significance of integrative medicine. Every chiropractor intending to be in practice for more than the next five years should investigate the Affordable Care Act, National Prevention Strategy, read the articles listed below and become acutely aware of the term, "Integrative Medicine." Your future is at stake and the implementation of integrative medicine and the Affordable Care Act will either enhance or impair your business success in the near future. Integrative medicine is the future and you should become a valuable member of an integrative medicine team as a provider of chiropractic medicine services. To remain isolated and outside of the healthcare system of the future is folly.
Suggested reading:
- Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Vol. 6. Washington, DC: National Academy Press; 2001.
- Davis K, Schoenbaum S, and Audet A-M. A 2020 Vision of Patient-Centered Primary Care. J Gen Intern Med. 2005 October; 20(10): 953–957.
- Maizes V, Rakel D, Niemiec C. Integrative medicine and patient-centered care. Explore (NY). 2009 Sep-Oct;5(5):277-89.
- Guarneri E, Horrigan BJ, Pechura CM. The efficacy and cost effectiveness of integrative medicine: a review of the medical and corporate literature. Explore (NY). 2010 Sep-Oct;6(5):308-12.
- Lehman JJ and Suozzi PJ. Founding Integrative Medicine Centers of Excellence: One Strategy for Chiropractic Medicine to Build Higher Cultural Authority. J Chiropr Educ. 2008 Spring; 22(1): 29–33.
